Heart failure & cardiomyopathiesCohort study
Heart transplantation allograft survival: donor atherosclerotic disease risk vs coronary angiography
- Retrospective cohort study
- registry (UNOS database)
- multivariable Cox regression
Authors' conclusion
Estimated ASCVD risk >5% independently predicts worse transplant outcomes, while routine coronary angiography in low-risk donors (ASCVD ≤5%) does not.
Study context
- Population
- Adult heart transplant recipients (UNOS database, 18 October 2018 to 31 December 2023) receiving hearts from donors aged >40 years, or >30 years with diabetes, hypertension or smoking
- Participants
- 5,152 recipients
- Exposure
- Donor 10-year atherosclerotic cardiovascular disease (ASCVD) risk with vs without donor coronary angiography
- ASCVD ≤5% with angiographyn = 3,378reference
- ASCVD ≤5% without angiographyn = 1,060
- ASCVD >5% with angiographyn = 663
- ASCVD >5% without angiographyn = 51
- Outcome
- Composite of:
- Death
- Graft failure
- Follow-up
- Up to 4 years post-transplant
Main finding
As reported in the abstract
Death or graft failure
Each group vs ASCVD ≤5% with angiographyAdjusted hazard ratio (95% CI)
ASCVD >5% with angiography
1.30(1.05–1.60)
Adjusted HR
- ASCVD ≤5% without angiography
- .91 (95% CI .74-1.11)
- ASCVD >5% without angiography
- .88 (95% CI .36-2.13)
Observational data: associations, not effects.
Further findings
Donor ASCVD risk and angiography use
- Recipients of hearts from donors with ASCVD risk ≤5%
- 86.1%
- Angiography performed, donors with ASCVD ≤5%
- 76.1%
- Angiography performed, donors with ASCVD >5%
- 92.9%
Death or graft failure, donors meeting current angiography guideline criteria
- Findings consistent when limited to donors meeting current angiography guideline criteria
Original publication
Heart transplantation allograft survival: donor atherosclerotic disease risk vs coronary angiography. Eur Heart J. Published 20 August 2026. doi:10.1093/eurheartj/ehag488
Summarised from the published abstract; every number is checked against it